Monday, 20 May 2013

PCO Publication

On Monday, May 20, 2013
“I am 25 years old, a newlywed and recently got diagnosed with PCOS. Every time I see baby things, watch baby stories on tv and in movies I get very emotional. I am very excited to start a family soon and now I hit this road block. I get a lot of positive talk that it is something that can be fixed and there still is hope, but to me it is devastating. I was also told that a lot of worrying can effect things too, that isn't good because I worry about everything under the sun. I am trying to lose weight, I just lost 18kg in a year for myself, so losing more sounds hard to do right now, I am not morbidly obese just a little extra here and there. Although I here PCOS is highly hereditary and my mother tried for 8 years to have me although she had normal menstrual cycles. If anyone could share with me their positive stories that have PCOS that would do me a world of good”

This was a genuine concern from one among many women who was diagnosed with polycystic ovary syndrome. Let us have a look about this condition.

What is polycystic ovary syndrome?
Polycystic ovary syndrome (PCOS) is a condition which can affect a woman’s menstrual cycle, fertility, hormones and aspects of appearance. It can also affect long-term health. 

What are polycystic ovaries?
Polycystic ovaries are slightly larger than normal ovaries and have twice the number of follicles (small cysts). Polycystic ovaries are very common affecting 20 in 100 (20%) of women. Having polycystic ovaries does not mean you have polycystic ovary syndrome. Around 6 or 7 in 100 (6-7%) of women with polycystic ovaries have PCOS. 

What are the symptoms of PCOS?
Irregular periods or no periods at all
Difficulty becoming pregnant (reduced fertility)
Having more facial or body hair than is usual for you (hirsutism)
Being overweight, rapid increase in weight, difficulty losing weight
Oily skin, acne
Depression and mood swings
The symptoms may vary from woman to woman. Being overweight increases the risk of developing symptoms.

What causes PCOS?
The cause of PCOS is not yet known. PCOS sometimes runs in families
The symptoms of PCOS are related to abnormal hormone levels. Testosterone is a hormone which is produced by the ovaries. Women with PCOS have slightly higher than normal levels of testosterone and this is associated with many of the symptoms of the condition.
Hormone Insulin also has a role. If you have PCOS, your body may not respond to the hormone insulin (known as insulin resistance), so the level of glucose is higher. To prevent the glucose levels becoming higher, your body produces more insulin. High levels of insulin can lead to weight gain, irregular periods, infertility and higher levels of testosterone.
This disorder affects the function of the ovaries, which produce eggs and the hormones oestrogen and progesterone. Other imbalances affect hormones produced by the brain and include elevated levels of luteinising hormone (LH) and a relative deficiency of follicle-stimulating hormone (FSH), both of which control the release of eggs from the ovaries. As the ovaries aren’t working properly, eggs may not be released in a regular monthly cycle. 

How is PCOS diagnosed?
PCOS is a syndrome where at least two of the following occur:

At least 12 follicles (tiny cysts measuring 2 to 9 mm) develop in your ovaries. (Polycystic means 'many cysts'.)
Ovulation may not occur regularly. Some women with PCOS do not ovulate at all. If you do not ovulate then you may not have a period.
The balance of hormones that are made in the ovaries is altered. In particular, the ovaries make more testosterone than normal.

How is it treated?
Unfortunately there is no cure for PCOS. However, symptoms can be treated, and the health risks can be reduced.
The cysts in polycystic ovaries are not harmful and do not need surgical removal.
If overweight, losing a few pounds may be enough to get the ovaries working properly again, as the more fat is carried, the higher the insulin levels are likely to be. Unfortunately, a lot of women with PCOS struggle for years to lose weight and have little success, so hormone treatment may be needed to restore the hormonal balance. 

Some women, who have no periods, or infrequent periods, do not want any treatment for this. However, the risk of developing cancer of the uterus (womb) may be increased if you have no periods for a long time or have less than four periods a year. Regular periods will prevent this increased risk to the uterus.
Possible treatments include the oral contraceptive pill , progestogen tablets taken to induce regular withdrawal bleeds or a progestogen releasing coil. 

An oral contraceptive Pill called Dianette is often used as it helps suppress testosterone levels and control acne and body hair growth
A promising new treatment currently being researched is a drug called Metformin, which makes tissues in the body more sensitive to insulin, helping bring insulin levels back to normal. However the current evidence is not enough to suggest that Metformin can improve fertility as well as the metabolic function in PCOS.
Finally, physical treatments such as electrolysis and laser hair removal are also helpful. 

Is infertility inevitable?
Not at all. Regular periods usually mean there isn’t a problem.  Irregular periods indicate irregular ovulation and about half of those with symptoms suffer from infertility as a result of not ovulating. The first treatment that’s usually tried is stimulation of the ovary with the tablet Clomiphene. This induces ovulation in about 70 per cent of women, and about half of these women will become pregnant within six months. If this fails, injections of FSH may be tried and this triggers ovulation in around 80 per cent of  women treated, of which about 60 per cent will conceive within six months. It’s vital, however, that ovarian stimulation is monitored by ultrasound in a fertility unit as women with PCOS have a tendency to develop a high number of eggs. This not only raises their risk of a multiple birth, but also of a potentially serious condition known as ovarian hyperstimulation syndrome (OHSS). 

Is laparoscopy has any role?
If drug treatment doesn’t work, laparoscopic surgery that involves cauterising the ovary(making few punctures)  is very successful in triggering ovulation without the risk of hyperstimulation. Laparoscopy can also can identify and treat the other causes of infertility if present.
Remember, you are much less likely to become pregnant if you are obese. If you are obese or overweight then losing weight is advised in addition to other fertility treatments. 

What are the long term health risks?
Diabetes – 10-20% women with PCOS go on to develop diabetes
High blood pressure
Heart disease
Cancer of the uterus

What can be done to reduce long-term health risks?
Healthy life style:
Healthy diet, regular exercise and weight reduction should help to reduce the long-term health risks.
You should aim to keep your weight to a level which is normal (a BMI between 19 and 25)
Regular health checks:
Women with PCOS over the age of 40 should be offered a blood sugar test once a year to check for signs of diabetes.
After the menopause it would be wise to have regular cholesterol and blood pressure checks so early signs of disease can be treated.
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Urinary Incontinence in Female

On Monday, May 20, 2013
Urinary incontinence is an embarrassing little problem, and lots of women -- regardless of age -- are secretly dealing with it.

What is urinary incontinence?
Urinary incontinence is the accidental release of urine. It can happen when you cough, laugh, sneeze, or jog. Or you may have a sudden need to go to the bathroom but can't get there in time. Bladder control problems are very common, especially among older adults. They usually don't cause major health problems, but they can be embarrassing.

Incontinence can be a short-term problem caused by a urinary tract infection, a medicine, or constipation. It gets better when you treat the problem that is causing it. But in majority, it is an ongoing problem

There are two main kinds of urinary incontinence. Some women-especially older women-have both.

Stress incontinence occurs when you sneeze, cough, laugh, jog, or do other things that put pressure on the bladder. It is the most common type of bladder control problem in women.

Urge incontinence happens when they have a strong need to urinate but can't reach the toilet in time. This can happen even when the bladder is holding only a small amount of urine. Some women may have no warning before they accidentally leak urine. Other women may leak urine when they drink water or when they hear or touch running water.

What causes urinary incontinence?

Bladder control problems may be caused by:

Weak muscles in the lower urinary tract.

Problems or damage either in the urinary tract or in the nerves that control urination.

Stress incontinence can be caused by childbirth, weight gain, or other conditions that stretch the pelvic floor muscles. When these muscles can't support your bladder properly, the bladder drops down and pushes against the vagina. You can't tighten the muscles that close off the urethra. So urine may leak because of the extra pressure on the bladder when you cough, sneeze, laugh, exercise, or do other activities

Urge incontinence is caused by an overactive bladder muscle that pushes urine out of the bladder. It may be caused by irritation of the bladder, emotional stress, or brain conditions such as Parkinson's disease or stroke. Many times doctors don't know what causes it.

Investigations
Your doctor will examine you and may do some simple tests to look for the cause of your bladder control problem. Some of the commonly used tests are:

·  Bladder diary Keep track of your symptoms and any leaking of urine with a bladder diary. This can help you and your doctor find the best treatment for you.

    Urinalysis. A sample of urine is sent to a laboratory, where it's checked for signs of infection, traces of blood or other abnormalities.

    Ultrasound also may be used to view other parts of the urinary tract or genitals to check for abnormalities.

    Urodynamic testing. These tests measure pressure in the bladder when it's at rest and when it's filling. A catheter is introduced into your urethra and bladder to fill the bladder with water. Meanwhile, a pressure monitor measures and records the pressure within the bladder. This test helps measure the bladder strength and urinary sphincter health, and it's an important tool for distinguishing the type of incontinence

How is it treated?
Treatments are different for each person. They depend on the type of incontinence you have and how much it affects your life. The treatment may include exercises, bladder training, medicines or a combination of these. Some women may need surgery.

There are also some things you can do at home. In many cases, these lifestyle changes can be enough to control incontinence.

· Cut back on caffeine drinks, such as coffee and tea.

· Eat foods high in fiber to help avoid constipation

· Stay at a healthy weight.

· Try simple pelvic-floor exercises like Kegel exercises.

· Go to the bathroom at several set times each day, and wear clothes that you can remove easily. Make your path to the bathroom as clear and quick as you can.

If you have symptoms of urinary incontinence, don't be embarrassed to tell your doctor. Most people can be helped or cured.

How can you prevent urinary incontinence?

Strengthening your pelvic muscles with Kegel exercises may lower your risk for incontinence.

Pelvic floor muscle exercises. These exercises strengthen your urinary sphincter and pelvic floor muscles — the muscles that help control urination. Your doctor may recommend that you do these exercises frequently. They are especially effective for stress incontinence, but may also help urge incontinence.

To do pelvic floor muscle exercises (Kegel exercises), imagine that you're trying to stop your urine flow. Squeeze the muscles you would use to stop urinating and hold for a count of three and repeat.

Medications
Often, medications are used in conjunction with behavioral techniques. Drugs commonly used to treat incontinence include:

Duloxetine  is sometimes used to treat stress incontinence.
Drugs like Tolteradine and Oxybutinine are used. Possible side effects of these medications include dry  mouth, constipation and blurred vision .Estrogen vaginal  creams or patch may help to improve the tone and rejuvenate tissues in the urethra and vaginal areas.

Surgery
If other treatments aren't working, several surgical procedures have been developed to fix problems that cause urinary incontinence.

Some of the commonly used procedures include:

Sling procedures
A sling procedure uses strips of synthetic material or mesh to create a pelvic sling or hammock around your bladder neck and urethra. The sling helps keep the urethra closed, especially when you cough or sneeze.  Tension-free vaginal tape (TVT) is a commonly used sling surgery. More than 85% of the persons get cured by this procedure.
    Bladder neck suspension. This procedure is designed to provide support to your urethra and bladder neck — an area of thickened muscle where the bladder connects to the urethra. It involves an abdominal incision, so it's done using general or spinal anesthesia.
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